Clinical Reasoning Process: Cornerstone of Effective Occupational Therapy Practice



Fig. 5.1
Integrative clinical reasoning (CR) process framework. (From the Australian Occupational Therapy Journal; Carrier et al. 2012)






Table 5.1
External and internal factors influencing the evolving clinical reasoning process. (Adapted from Carrier et al. 2012)









































































External factors

Description

Client
 

Availability (emotional, cognitive, physical)

Includes personality, openness to intervention, personal (e.g., level of education, learning style and speed), and functional characteristics (e.g., functional profile, type of disabilities, prognosis)

Functional characteristics interact closely with the task (e.g., determine the objective)

Previous knowledge

Task knowledge and habits

Environment
 

Client’s physical and social environment

Physical and social obstacles and facilitators

Availability of tools

Tool(s) available or not when intervening

Occupational therapist’s practice context

Includes physical location of the intervention, organizational factors (e.g., underlying values, implicit and explicit rules), work organization, and social environment (colleagues)

Influence of the practice context is modulated by the OT’s personality

Task
 

Content

Type, complexity, and quantity of tasks (e.g., number of pieces of equipment involved)

Objective

Determined by the client’s particular characteristics and environment (e.g., familiarize versus teach how to do it)

Interaction of Factors
 

Client–environment interaction

Degree of correspondence between the client and his/her social and physical environment

Task–environment interaction

Degree of correspondence between the task, equipment used, and place where it is done

Degree of difficulty/safety

Difficulty experienced by the client and risk to the client’s safety when performing the task during assessment and intervention

Result of the strategy

Success or failure of the intervention strategy

The result may be anticipated (prior to using the strategy) or evaluated from the client’s reactions (after using the strategy)

Internal factors

Description

Knowledge and experiences (professional and personal)

Includes: Knowledge about (1) assessments, interventions, and equipment; (2) client’s availability with respect to intervention

Experiences regarding clients’ reactions and characteristics, assessments, interventions, and equipment

Acquisition of new knowledge and experiences sustains the development of the intervention plans that are available to the OT

Personal habits

Usual way of intervening in this type of clinical situation (corresponds to the profile–plan match)

Preparation

Degree of preparation for intervening; the need to prepare depends on the OT’s knowledge and experiences

Availability (emotional, cognitive, physical)

Includes personality, degree of cognitive and physical fatigue, and openness to reactions from the client and his/her social environment. These reactions indicate the results of the strategy used

View of occupational therapy

A two-way, interactive and dynamic process modulated in terms of intensity


OT occupational therapist




Table 5.2
The eight stages of the clinical reasoning process. (Adapted from Carrier et al. 2012)















































Stages

Description of occupational therapists’ cognitive actions

Phase 1—Development of the intervention plan

1.

Gathering information

Collect information about external factors related to the client, the environment, the task, and their mutual interaction
   
 Determined by the knowledge occupational therapists have of their client and his/her situation; less knowledge = more detailed information gathering

 May be limited by organizational elements of the practice context, such as the lack of information in medical records and referrals

2.

Picturing the clinical situation

Develop a picture of the clinical situation
   
 May be more or less complete, depending on the comprehensiveness of the information obtained in stage 1, with potential later effects on the choice of interventions

3.

Matching to the generic profile (a)

and the intervention plan (b)

(a) Link the picture of the clinical situation to the generic profile that fits best from the occupational therapist’s own bank of profiles

 Bank content depends on the occupational therapist’s experience

 May be possible to estimate the level of complexity of the clinical situation, which is related to external factors collected during stage 1
   
(b) Match the generic profile to a particular sequence of therapeutic actions (or intervention plan)

 Influenced by emotional availability and specifically personality

 Matching is the usual way to intervene in a particular situation (personal habits)

 Intervention plans available depend on experience and knowledge

 If knowledge of client is insufficient and client s availability is unknown, a “general” intervention plan, which includes varied strategies involving a wider range of methods, is used

Phase 2—Finalization of the choice of intervention plan

4.

Assessing the plan

Go back to the picture of the clinical situation and assess the plan in regard to:

 Occupational therapist’s own availability and readiness to intervene

 Availability of the tool being considered (e.g., equipment)

 Anticipated efficacy of the plan (results obtained)

 State of their therapeutic relationship with the client (i.e., emotional link between therapist and client and, if applicable, the client’s social environment)

5.

Choosing to use (or not use) the plan

Choose to use the plan, or to postpone or end the intervention

 Clients are consulted about the plan to get their agreement. The action of consulting is influenced by the way therapy is viewed and the physical location of the intervention, e.g., the client’s home (element of the practice context)

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May 21, 2017 | Posted by in GENERAL | Comments Off on Clinical Reasoning Process: Cornerstone of Effective Occupational Therapy Practice
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